When a disaster, whether natural or manmade, overwhelms the resources and capabilities of local organizations, responders come in from other cities, counties, and states—jurisdictions near and far—as well as from federal agencies, to assist those with local responsibility. Skilled support workers are engaged for specialized activities, such as removing debris and restoring utilities and transportation. Neighbors and other volunteers may travel to the disaster site to try to do their part. Other concerned individuals and organizations send food, supplies, and equipment. Journalists press in to the closest possible vantage points to get the pictures and stories. Public officials arrive to examine the damage and consult with the responders. One characteristic of these large, rare, dynamic events is the rapidly evolving complexity that faces individuals trying to effectively manage all of the organizations and people, operations and tasks, equipment and supplies, communications, and the safety and health of all involved. Another characteristic is that all disasters present risks to emergency response workers—risks that may be familiar or unfamiliar, and that may vary widely depending on the nature of the event or the phase of the response.

This report addresses the protection of emergency responders against injury, illness, and death on just such rare occasions, when emergencies become disasters. It builds on a broad base of National Institute for Occupational Safety and Health programs and RAND Corporation research on protecting emergency responders. This report focuses on preparedness (especially planning and training) and management as means of controlling and reducing the hazards emergency responders face. It provides a set of recommendations on how disaster site safety and health management might be improved. Much of the information contained herein is based upon the firsthand experience and suggestions of emergency responders who were there at the World Trade Center and at the Pentagon on and after September 11, as well as those who responded to the Northridge earthquake (in California) and Hurricane Andrew (in Florida).

This report builds on systems and practices currently in use and was developed primarily for use by local emergency responders, those individuals and organizations who have been tasked with disaster site safety and health responsibilities. Additionally, the report should prove useful to legislators and other federal, state, county, and municipal officials; trade union officials; industry executives; safety and health professionals; and researchers who are engaged in and committed to efforts to make our nation more secure, to respond effectively and safely to disaster, and to protect a critically important resource—the community of emergency responders.

John Howard, M.D.

Director, National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention

Stephen Rattien
Director RAND Science and Technology, a division of the RAND Corporation

The RAND Corporation Quality Assurance Process

Peer review is an integral part of all RAND research projects. Prior to publication,
this document, as with all documents in the RAND monograph series, was subject to
a quality assurance process to ensure that the research meets several standards, including
the following: The problem is well formulated; the research approach is well
designed and well executed; the data and assumptions are sound; the findings are useful
and advance knowledge; the implications and recommendations follow logically
from the findings and are explained thoroughly; the documentation is accurate, understandable, cogent, and temperate in tone; the research demonstrates understanding
of related previous studies; and the research is relevant, objective, independent,
and balanced. Peer review is conducted by research professionals who were not
members of the project team.

RAND routinely reviews and refines its quality assurance process and also conducts
periodic external and internal reviews of the quality of its body of work. For
additional details regarding the RAND quality assurance process, visit http://www.rand.org/standards/.

Acknowledgments

An effort of this scope would clearly not be possible without the assistance of many people and organizations. A large number of individuals gave generously of their time and expertise to participate in both data-gathering discussions and the workshop held as part of the project. They are listed in Appendix A of the report.

In addition, a range of organizations assisted in the project by direct participation of their leadership or staff in topical discussions and/or by helping the project team connect with critical expertise within the response community. Their assistance was invaluable in ensuring that an effort of this breadth could tap needed expertise from the response community. In particular, we would like to thank the following organizations:

International Association of Chiefs of Police International Association of Fire Chiefs International Association of Fire Fighters National Association of Emergency Managers National Association of Emergency Medical Technicians National Emergency Management Association National Fire Protection Association National Voluntary Organizations Active in Disasters Oklahoma City Memorial Institute for the Prevention of Terrorism United States Fire Administration

We would like to single out several individuals who gave very generously of their time in both speaking to us and helping us connect with other individuals and information sources. They are Chief Allen Hay of the Fire Department of New York, Tania Hedlund of the New York Police Department, Bill Johnson of the Miami- Dade Fire Rescue Department’s Office of Emergency Management, Kirby Kiefer of the United States Fire Administration, Frank Koutnik of the Florida Department of Community Affairs’ Division of Emergency Management, Joseph Morris of the Port Authority of New York and New Jersey, and Vicki Lee of the International Association of Fire Chiefs. Mike Tammilow, from the National Urban Search & Rescue Response System, also generously provided information to the study team. In addition, we would like to thank the staff of the Learning Resource Center, United States Fire Administration, for their research assistance. The authors would also like to gratefully acknowledge the many individuals and organizations that participated in review of the draft report.

Many individuals within the National Institute for Occupational Safety and Health made important contributions both to guiding the study effort and to the content of the research as well. We would like to acknowledge Kathleen Rest, deputy director for programs of NIOSH; Scott Deitchman, assistant director for emergency preparedness; Nancy Stout, director of the Division of Safety Research; and Tim Pizatella, deputy director of the Division of Safety Research, for their leadership and support of the project. We would particularly like to acknowledge Thomas Hodous, the initial NIOSH project officer for the study. In addition to his management roles, he participated closely in the research effort and made important contributions to the study. The project also benefited from access to a distinguished team within NIOSH that brought together a broad range of expertise on occupational safety and health. Beyond those who have already been mentioned, they were Dawn Castillo, Terrence Cloonan, Robert Koedam, Ken Mead, Paul Middendorf, Kara Perritt, Carol Merry Stephenson, Jim Spahr, Jon Szalajda, and Ralph Zumwalde. Through project discussions and other input, they provided the study with the benefit of a much broader body of knowledge than would have otherwise been available.

The success of this project would also not have been possible without the involvement of a range of RAND colleagues as both direct participants in data gathering or as contributors of their own subject matter expertise. Given the interdisciplinary nature of the topic, the project team drew on the talents of researchers across RAND with experience in military command and force protection, health care issues, and the science and technology field. Beginning with the initial literature review and interview process, Ari Houser, Suzannah Sennetti, Sophia Washam, and Irene Brahmakulam played critical roles.

Later in the project, a larger group of individuals participated in discussions as moderators and subject matter support to the project workshop and in other roles. They included Donna Barbisch, Gary Cecchine, Noreen Clancy, Robert Howe, David Howell, David Johnson, David Kassing, Debra Knopman, Beth Lachman, Henry (Chip) Leonard, Ralph Masi, David Mosher, David Mussington, D. J. Peterson, Steve Rattien, Helga Rippen, Liz Sloss, Jerry Sollinger, Bradley Stein, Terri Tanielian, Michael Tseng, Mike Wermuth, and Henry Willis. Lieutenant Colonel Scott O’Neil, an Army fellow at RAND who participated in the project, made important contributions. We also benefited from support and input from Bruce Don, Jeff Isaacson, Tom McNaugher, Bernie Rostker, Mark Wang, and Kathi Webb. We would also like to thank Aarti Dalal, Aryn Thomas, and Leigh Stallings for their administrative efforts on behalf of the project.

In particular, we would like to acknowledge the efforts of Susan Bohandy of the RAND Research Communications group in the preparation and refinement of the project report. Susan’s efforts were instrumental in improving the quality of the report during the intense final stages of the project. The project team is grateful for her hard work in helping bring the study to a successful conclusion.

About the Authors

Brian A. Jackson
Brian Jackson is a physical scientist at RAND and coprincipal investigator of this
study. Recent research areas include equipment and technology needs of emergency
responders, terrorism preparedness, critical infrastructure protection, and cyber security.
He holds a bachelor’s degree in chemistry from Haverford College, a master’s
degree in science, technology, and public policy from the George Washington University,
and a PhD in chemistry from the California Institute of Technology.

John C. Baker
John C. Baker is a policy analyst at RAND and coprincipal investigator of this study.
Recent research areas include homeland security and remote sensing. He is a graduate
of American University (bachelor of arts in international studies) and Columbia University
(master of philosophy in political science).

M. Susan Ridgely
M. Susan Ridgely is a senior policy analyst at RAND. In addition to contributing to
the health and behavioral health components of this study on safety management,
her recent research activities have focused on patient safety in health care settings;
access to health care by ethnic minorities; and the implementation of federal health
care policy on states, local communities, health plans, and health care providers. She
holds a bachelor’s degree in psychology from Bryan College, and the degrees of
MSW and JD from the University of Maryland.

James T. Bartis
James T. Bartis is a senior policy analyst at RAND. His research interests are in the
areas of national security, including terrorism response, energy policy, and research
and development planning. He is a graduate of Brown University (ScB in chemistry)
and the Massachusetts Institute of Technology (PhD in chemical physics).

Herbert I. Linn
Herbert I. Linn is associate director for Communications at the NIOSH Division of
Safety Research and project officer for this study. His principal efforts focus on communicating information on the risk and prevention of traumatic occupational
injuries. Recently, he has conceived and participated in studies on the use of computer
tailoring in preparing risk and prevention information, and the use of narratives
in toolbox training programs. He holds a bachelor’s degree in English from
Fairmont State College and a master’s degree in safety from Marshall University.

The National Institute for Occupational Safety and Health

The National Institute for Occupational Safety and Health (NIOSH) is the federal
agency responsible for conducting research and making recommendations for the
prevention of work-related injury and illness. NIOSH is part of the Centers for Disease
Control and Prevention (CDC) in the Department of Health and Human
Services.

The Occupational Safety and Health Act of 1970 created both NIOSH and the
Occupational Safety and Health Administration (OSHA). OSHA is in the U.S. Department of Labor and is responsible for developing and enforcing workplace safety
and health regulations. NIOSH is in the U.S. Department of Health and Human
Services and is an agency established to help assure safe and healthful working conditions
for working men and women by providing research, information, education,
and training in the field of occupational safety and health. NIOSH provides national
and world leadership to prevent work-related illness, injury, disability, and death by
gathering information, conducting scientific research, and translating the knowledge
gained into products and services. NIOSH’s mission is critical to the health and
safety of every American worker. Each day, an average of 9,000 U.S. workers sustain
disabling injuries on the job, 16 workers die from an injury suffered at work, and
137 workers die from work-related diseases. The Liberty Mutual 2002 Workplace
Safety Index estimates that direct costs for occupational injuries in 1999 rose to
$40.1 billion, with indirect costs reaching over $200 billion.

The Institute’s responsibilities include:

• Conducting a focused program of research to reduce injuries and illnesses among workers in high-priority areas and high-risk sectors, including mining, agriculture, construction, and health care.
  
  
• Implementing and maintaining a system of surveillance for major workplace illnesses, injuries, exposures, and health and safety hazards.
  
  
• Increasing prevention activities through workplace evaluations, interventions, and recommendations.
  
  
• Providing workers, employers, the public, and the occupational safety and health community with information, training, and capacity to prevent occupational injuries and illnesses.

NIOSH is headquartered in Washington, DC, with research laboratories and
offices in Cincinnati, OH; Morgantown, WV; Pittsburgh, PA; Spokane, WA; and
Atlanta, GA. NIOSH is a professionally diverse organization with a staff of over
1,400 people representing a wide range of disciplines including epidemiology, medicine,
industrial hygiene, safety, psychology, engineering, chemistry, and statistics.

For further information regarding the National Institute for Occupational Safety and Health or worker safety and health, please contact:

John Howard
Director, National Institute for Occupational Safety and Health
Hubert H. Humphrey Building
Room 715H
200 Independence Avenue, S.W.
Washington, DC 20201
Web: http://www.cdc.gov/niosh
Phone: 1-800-35-NIOSH (1-800-356-4674)

The Science and Technology Policy Institute

Originally created by Congress in 1991 as the Critical Technologies Institute and
renamed in 1998, the Science and Technology Policy Institute is a federally funded
research and development center sponsored by the National Science Foundation.
The S&TPI was managed by the RAND Corporation from 1992 through November
30, 2003.

The institute’s mission is to help improve public policy by conducting objective,
independent research and analysis on policy issues that involve science and technology.
To this end, the Institute

• supports the Office of Science and Technology Policy and other Executive Branch agencies, offices, and councils
  
  
• helps science and technology decisionmakers understand the likely consequences of their decisions and choose among alternative policies
  
  
• helps improve understanding in both the public and private sectors of the ways in which science and technology can better serve national objectives.

In carrying out its mission, the Institute consults broadly with representatives from private industry, institutions of higher education, and other nonprofit institutions. Inquiries regarding the work described in this report may be directed to the address below.

Stephen Rattien
Director
RAND Science and Technology
1200 South Hayes Street
Arlington, VA 22202-5050
Web: http://www.rand.org/scitech/
Phone: (703) 413-1100 x5219

Acronyms and Abbreviations